From the Editor's Desk: Welcome to Spring!
Authors: Amedee RG PMID: 29559856 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - March 23, 2018 Category: General Medicine Tags: Ochsner J Source Type: research

Welcome Home and Welcome to the Healthcare Team at Ochsnera.
Authors: Amedee RG PMID: 29559857 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - March 23, 2018 Category: General Medicine Tags: Ochsner J Source Type: research

Letter to the Editor: Diagnosing Mitochondrial Encephalomyopathy With Lactic Acidosis and Stroke-Like Episodes (MELAS) Requires Not Only Phenotypic But Also Genotypic Verification.
Authors: Finsterer J, Zarrouk-Mahjoub S PMID: 29559858 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - March 23, 2018 Category: General Medicine Tags: Ochsner J Source Type: research

Letter to the Editor: Contemporary Screening and Treatment of Hypertrophic Cardiomyopathy.
Authors: Darmoch F, Soud M, Al-Khadra Y, Pacha HM, Alraies MC PMID: 29559859 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - March 23, 2018 Category: General Medicine Tags: Ochsner J Source Type: research

Letter to the Editor: Bicuspid Aortic Valve-Family Screening and Indications for Intervention.
Authors: Baibars M, Darmoch F, Kabach A, Fanari Z, Alraies MC PMID: 29559860 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - March 23, 2018 Category: General Medicine Tags: Ochsner J Source Type: research

Letter to the Editor: Digital Dementia-Is Smart Technology Making Us Dumb?
Authors: Moledina S, Khoja A PMID: 29559861 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - March 23, 2018 Category: General Medicine Tags: Ochsner J Source Type: research

Clinical Images: A Rare Case of Cryptococcal Meningoencephalitis in an Immunocompetent Patient.
Authors: Arndt S, Goldman D, Kolodychuk N, Milburn J PMID: 29559862 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - March 23, 2018 Category: General Medicine Tags: Ochsner J Source Type: research

Bioethics in Practice: The Ethics Surrounding the Use of Donor Milk.
Authors: Thibeau S, Ginsberg HG PMID: 29559863 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - March 23, 2018 Category: General Medicine Tags: Ochsner J Source Type: research

The Opioid Epidemic and Pain Medicine Specialists: Where to Begin and What Is Next?
Authors: Tolba R, Meselhy E, Guerra CE PMID: 29559864 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - March 23, 2018 Category: General Medicine Tags: Ochsner J Source Type: research

Suboxone: Rationale, Science, Misconceptions.
Authors: Velander JR PMID: 29559865 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - March 23, 2018 Category: General Medicine Tags: Ochsner J Source Type: research

Intelligent Clinical Decision Support to Improve Safe Opioid Management of Chronic Noncancer Pain in Primary Care.
Conclusion: Health system research that examines workflow-focused strategies to improve physician knowledge and skills for safely managing opioid therapy is needed. If EMR CDS proves to be effective in increasing adherence to practice guidelines, this EMR strategy can potentially be replicated and scaled up nationwide to improve population health management. PMID: 29559866 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - March 23, 2018 Category: General Medicine Tags: Ochsner J Source Type: research

Opiate Prescribing Practices in the Postpartum Unit.
Conclusion: Despite a high number of outpatient narcotics prescriptions, approximately 1 in 5 patients initiated an encounter to address pain after vaginal delivery. Parity may play a role in postpartum inpatient narcotic usage, possibly because multiparous patients have had prior exposure to narcotics use in postpartum care. PMID: 29559867 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - March 23, 2018 Category: General Medicine Tags: Ochsner J Source Type: research

Reducing Opioid Prescribing Rates in Emergency Medicine.
Conclusion: Provider performance transparency using unblinded and transparent data analytics can efficiently and significantly alter provider practice. PMID: 29559868 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - March 23, 2018 Category: General Medicine Tags: Ochsner J Source Type: research

Patient-Centered Beliefs Among Patients and Providers in Kazakhstan.
Conclusion: Only a small percentage of doctors, nurses, and patients reported that their interaction should be patient-centered. This congruence between providers and patients does not explain dissatisfaction, but the finding that patient-centered patients were more satisfied suggests an area for improvement. PMID: 29559869 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - March 23, 2018 Category: General Medicine Tags: Ochsner J Source Type: research

The Submental Island Flap Is a Viable Reconstructive Option for a Variety of Head and Neck Ablative Defects.
Conclusion: The SIF is a robust flap that can be reliably used for a variety of head and neck defects following tumor ablation with an acceptable rate of donor- and flap-related complications. PMID: 29559870 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - March 23, 2018 Category: General Medicine Tags: Ochsner J Source Type: research

Radiofrequency Ablation of Pericranial Nerves for Treating Headache Conditions: A Promising Option for Patients.
We present our experience with using radiofrequency ablation (RFA) for pericranial nerves to treat chronic headache conditions. Methods: This retrospective analysis included patients who received RFA for pericranial nerves to treat chronic daily headache conditions from January 1, 2015 to June 1, 2016. Outcomes were pain scores as measured on the visual analog scale (with 0 representing no pain and 10 representing the worst pain imaginable) and the patient-reported percent improvement in headache conditions, including pain scores, severity, duration, frequency, and associated symptoms. Results: Of the 57 patients w...
Source: Ochsner Journal - March 23, 2018 Category: General Medicine Tags: Ochsner J Source Type: research

Pulsed Radiofrequency for Treating Trigeminal Neuralgia.
Conclusion: PRF through the transcoronoid approach may be a safe and effective approach for treating trigeminal neuralgia in patients resistant to conservative management. PMID: 29559872 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - March 23, 2018 Category: General Medicine Tags: Ochsner J Source Type: research

Physician Body Mass Index and Bias Toward Obesity Documentation Patterns.
Authors: Berry AC, Berry NA, Myers TS, Reznicek J, Berry BB Abstract Background: Many healthcare professionals consider obese individuals to be unmotivated and to lack the willpower to follow through with weight-loss plans. This attitude may result in less effort put into diagnosing, documenting, and treating obesity. Our aim was to assess documentation patterns of obesity and hypertension overall, by primary care specialty, and in relation to provider body mass index (BMI). Methods: Twenty-two physicians from one outpatient community practice were included: 10 internal medicine and 12 family practice practitio...
Source: Ochsner Journal - March 23, 2018 Category: General Medicine Tags: Ochsner J Source Type: research

Factors Affecting the Completion of Genitourinary Physical Examinations Prior to Urologic Consultation.
Conclusion: Prior to urologic consultation, GU examinations are inconsistently performed. This variability may affect patient care and could be the subject of a future study. PMID: 29559874 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - March 23, 2018 Category: General Medicine Tags: Ochsner J Source Type: research

Immunomodulator and Biologic Agent Effects on Sleep Quality in Patients With Inflammatory Bowel Disease.
Conclusion: The majority of patients with IBD experience some degree of sleep impairment, and treatment with immunomodulators and biologic agents does not appear to improve sleep quality. A multicenter study with a larger sample size is warranted to better assess the diverse population of patients with IBD and the factors that impact their sleep. Routine assessment of sleep quality during IBD clinical encounters is recommended. PMID: 29559875 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - March 23, 2018 Category: General Medicine Tags: Ochsner J Source Type: research

Dietary Glycine Is Rate-Limiting for Glutathione Synthesis and May Have Broad Potential for Health Protection.
Conclusion: Clinical research is warranted to evaluate the impact of supplemental glycine on glutathione levels and on various health disorders. PMID: 29559876 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - March 23, 2018 Category: General Medicine Tags: Ochsner J Source Type: research

Pulsed Radiofrequency Ablation for Treating Sural Neuralgia.
Conclusion: Pulsed radiofrequency ablation may be a safe and effective treatment for patients with sural neuralgia that does not respond to conservative therapy. However, studies are needed to elucidate its effectiveness and safety profile. PMID: 29559877 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - March 23, 2018 Category: General Medicine Tags: Ochsner J Source Type: research

Radiofrequency Ablation for Treating Resistant Intercostal Neuralgia.
Conclusion: Our cases suggest that thermal RFA can be safely used to treat patients suffering from intercostal neuralgia. This unique treatment has significant implications for chronic pain physicians and warrants additional studies to elucidate its effectiveness, safety profile, and scope of use. PMID: 29559878 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - March 23, 2018 Category: General Medicine Tags: Ochsner J Source Type: research

Polyarteritis Nodosa in Pregnancy.
Conclusion: We present the case to stress the value of careful physical examination in unveiling the presence of a rare disease. PMID: 29559879 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - March 23, 2018 Category: General Medicine Tags: Ochsner J Source Type: research

Acute Calcific Tendonitis of the Longus Colli.
Conclusion: The clinical presentation and laboratory findings of ACTLC are nonspecific; however, a CT scan revealing a calcific deposition in the retropharyngeal space confirms the diagnosis. Spontaneous resolution during the course of several weeks warrants conservative treatment with analgesia and antiinflammatory medications. Awareness of ACTLC must be increased to avoid diagnostic errors and prevent unnecessary medical interventions. PMID: 29559880 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - March 23, 2018 Category: General Medicine Tags: Ochsner J Source Type: research

Atypical Presentation of Extramedullary Plasmacytoma.
Conclusion: This case is a unique example of a patient with an extramedullary plasmacytoma with no diagnostic signs of multiple myeloma. PMID: 29559881 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - March 23, 2018 Category: General Medicine Tags: Ochsner J Source Type: research

Mycotic Pulmonary Artery Aneurysm Mimicking a Rasmussen Aneurysm.
Conclusion: While mycotic aneurysms are uncommon, certain clinical scenarios warrant consideration of the diagnosis, such as a history of intravenous drug use, bacterial endocarditis, and immunocompromise. Rapid identification is critical to prevent life-threatening complications such as vessel rupture. Computed tomography allows for an accurate and timely diagnosis, and interventional embolization is a fast, minimally invasive curative treatment. Given similar risk factors and presentation, a mycotic aneurysm can be indistinguishable from a Rasmussen aneurysm; therefore, appropriate precautions should be taken while adequ...
Source: Ochsner Journal - March 23, 2018 Category: General Medicine Tags: Ochsner J Source Type: research

From The Editor's Desk: A Focus on Cancer Services.
Authors: Amedee RG PMID: 29230106 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

From the Guest Editor: The Rapidly Changing Field of Cancer Treatment.
Authors: Ramirez RA PMID: 29230107 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Letter To The Editor: Ertapenem-Induced Acute Pancreatitis in a Cirrhotic Patient.
Authors: Oztas E, Akpinar MY, Kaplan M PMID: 29230108 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Letter To The Editor: Reply to Polio Eradication in Pakistan: Call for Alliance.
Authors: Ullah MA, Husseni AM PMID: 29230109 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Letter To The Editor: Management of Aortic Root Thrombosis After Implantation of a Continuous-Flow Left Ventricular Assist Device: A Real Conundrum.
Authors: Gulotta J, Morin DP, Krim SR PMID: 29230110 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Letter To The Editor: Catheter Track Metastasis With Indwelling Pleural Catheter.
Authors: Zank S, Abboud E, Jaber W, Alraiyes AH PMID: 29230111 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Clinical Images: Transjugular Intrahepatic Portosystemic Shunt Reduction for Management of Recurrent Hepatic Encephalopathy.
Authors: Khalili H, Goldman D, Frischhertz S, Kirsch D PMID: 29230112 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Bioethics In Practice: Understanding Understood Consent.
Authors: Vasquez RJ PMID: 29230113 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Building a Phase 1 Cancer Research Program: Lessons Learned and Progress Made.
Authors: Matrana MR, Cook J PMID: 29230114 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Interval Colorectal Cancers at Ochsner Medical Center: Where Do We Stand?
Authors: Humphrey F, Gastañaduy M, Smith J, Whitlow CB Abstract Background: An interval colorectal cancer is a cancer diagnosed prior to the recommended follow-up time from a previously negative colonoscopy. These cancers are thought to arise from a rapidly growing cancer, missed cancer, or incompletely resected adenomas. Our study aimed to identify interval cancers diagnosed during a 4-year period and to identify any potential risk factors associated with these cancers. Secondly, we compared our interval colorectal cancer rate with other published rates. Methods: Our population included all patients who...
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Overall Survival Associated With Ileostomy Closure in Patients With Rectal Cancer Before and After Adjuvant Therapy.
Conclusion: Long-term survival was similar in patients who underwent ileostomy closure before and after adjuvant therapy following low anterior resection for rectal cancer. While this study was underpowered, it adds additional insight to an area of surgery lacking significant data. The timing of ileostomy closure should be individualized for each patient. PMID: 29230116 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Outcomes of Patients With Late-Relapse Metastatic Renal Cell Carcinoma Treated With Targeted Therapies: A Single Institution Experience.
Conclusion: Patients with late-relapse mRCC treated with targeted therapy had prolonged survival that compared favorably to historical controls, and metastases in uncommon sites were noted. PMID: 29230117 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Prognostic Factors in Typical and Atypical Pulmonary Carcinoids.
We report the findings of the Ochsner Medical Center/Louisiana State University (LSU) Health Sciences Center neuroendocrine tumor (NET) program. Methods: A database with all patients seen at the Ochsner Medical Center/LSU NET program was queried for patients with bronchopulmonary NET. We included patients who had confirmed pathologic bronchopulmonary carcinoid and who had at least 1 clinic visit. Patients with large or small cell NETs or diffuse idiopathic pulmonary neuroendocrine cell hyperplasia were excluded. Results: A total of 169 patients seen from January 1996 to March 2015 met the inclusion criteria. The me...
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

A Potential Additional Variable to Consider in the Surgical Treatment of Ductal Carcinoma in Situ.
Conclusion: Based on these results, an HER2-positive ductal carcinoma in situ is likely to be larger than an HER2-negative tumor, leading to more frequent use of mastectomy. This finding would explain our poor recruitment to the National Surgical Adjuvant Breast and Bowel Project Protocol B-43 trial. PMID: 29230119 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

The Relationship Between Regional Anesthesia and Cancer: A Metaanalysis.
Conclusion: This metaanalysis shows that RA has no overall survival, recurrence-free survival, or biochemical recurrence-free survival benefit. However, some individual studies have shown significant benefit in terms of cancer recurrence. Further, RA reduces the use of opioids, which has led to some secondary benefits. Further studies are needed to establish the benefits of RA as it relates to cancer. PMID: 29230120 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Leptomeningeal Disease and the Evolving Role of Molecular Targeted Therapy and Immunotherapy.
Conclusion: Targeted molecular therapy and immunotherapy in LMD may provide favorable treatment options. Current literature is lacking in safety, efficacy, and overall response rates from the use of targeted therapy. Research is needed to draw significant conclusions about the most appropriate therapy for patients with LMD. PMID: 29230121 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

The Role of Checkpoint Inhibition in Non-Small Cell Lung Cancer.
Conclusion: Treatment of NSCLC is constantly changing, and new immune checkpoint inhibitors have shown promising results. Clinical trials are examining their use in the adjuvant setting and in combination with other therapies, and these combination therapies have the potential to show even greater benefits and broader applications than the individual drugs themselves. PMID: 29230122 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Molecular Targets in Non-Small Cell Lung Cancer.
Conclusion: Patients with advanced NSCLC should undergo mutational testing to evaluate for actionable mutations. If such a mutation is discovered, targeted therapy should be considered for first-line treatment. PMID: 29230123 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Oncology and Palliative Medicine: Providing Comprehensive Care for Patients With Cancer.
Conclusion: Palliative medicine has a wide-ranging role in the spectrum of comprehensive cancer care-from patient diagnosis to survivorship. The entire multidisciplinary care team has a role in providing palliative care in inpatient and outpatient settings. An effective palliative medicine and oncology collaboration improves patient care and quality of life, has broad research and guideline support, and is cost effective. PMID: 29230124 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Older Patients With Acute Myeloid Leukemia: Treatment Challenges and Future Directions.
Conclusion: Older patients with AML are candidates for and benefit from the entire spectrum of AML therapy, including intense chemotherapy, allogeneic stem cell transplant, and clinical trial participation after thorough patient assessment. Older patients with AML would benefit from increased clinical trial enrollment and early inclusion of palliative medicine. PMID: 29230125 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Endocrine Therapy for Early Breast Cancer: Updated Review.
Conclusion: With the implementation of such therapies resulting in decreased mortality, patients with breast cancer are living longer than ever before. The focus of research is now directed toward the length of treatment and prediction models for recurrence. PMID: 29230126 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Intraarterial Liver-Directed Therapies: The Role of Interventional Oncology.
Conclusion: Interventional oncology and its image-guided intraarterial therapies continue to gain recognition as treatment options for primary and secondary liver cancers. Growing evidence supports their role as a standard of care alongside medical oncology, surgery, and radiation oncology. PMID: 29230127 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Sigmoid Colonic Polyp as Initial Presentation of Metastatic Papillary Renal Cell Carcinoma.
Conclusion: To the best of our knowledge, this patient had a rare case of metastatic papillary renal cell carcinoma that metastasized to the colon and presented as a colon polyp. PMID: 29230128 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research